Factors affecting mental health practice in Dar es salaam and Dodoma, Tanzania: The nursing perspective.

Abstract

Introduction: Recently, hospital management teams have experienced and received reports that are highly suggestive of elements of inadequate mental health care. Adverse events such as patient killing one another in the psychiatric wards are one among incidences that indicate the degree or severity of deterioration of the quality of mental health practice. Limited infrastructure makes patients cared for in a non therapeutic milieu; non-conducive working environment for nurses, including high workload, creating more demands from patients and their significant others. These factors compromise the quality of care provided and this affects the motivational factors for nur ses working in mental health care. Understanding factors affecting mental health practice will be vital in correcting this anomaly. Objective: The study aimed at determining factors affecting mental health nursing practice in Tanzania. Methodology: The study deployed a descriptive qualitative design at Mirembe National Hospital for Mental Health and Muhimbili National Hospital. A total of 27 nurses participated in providing information through focused group discussions and in depth interviews were by 16 nurses were Muhimbili and 11 nurses from Mirembe National Hospital. Also a total of 10 nurses in charges and managers were involved in filling up the institutional quality assessment tool. Sessions were audio recorded, transcribed, analyzed and translated. Findings: Un-conducive working environment was the main factors affecting mental health nursing practice in which there was low motivation to nursing staffs, lack of on job training for long time, limited infrastructure in mental health facilities, high workload, unguaranteed safety at work place, and nursing leadership in mental health units affected performance. Other factors included shortage of qualified nurses trained in mental health, limited treatment modalities, poor environments for hospitalized patients, inadequate funding of mental health services and absence of community mental health nursing. It was found that both facilities performed well in Case management for severe psychiatric disorders and length of treatment for substance – related disorders, specifically MNH also performed well in writing the patients’ daily progress report while Mirembe Hospital had few hospital readmissions for psychiatric patients. Generally both institutions performed below standard in most areas assessed hence there is a need to employ some measures to improve the quality of care. Conclusion and recommendations There is a need for the government to provide adequate budget for financing mental health services which could enable to hospital managements improve the working environment and motivate nurses and increase their engagement in their work also to have effective community mental health nursing and training to nurses working in mental health settings. Mental health nursing needs to be provided by well trained and competent nurses in this area. Future research should investigate whether these findings remain consistent in other mental health facilities also there is a need to undergo study to find the impact of patients being enclosed in the wards for most of their hospitalized period.